持续静脉-静脉血液滤过对危重症甲型H1N1流感患者呼吸功能的影响  

Effects of continuous vencrvenous hemofiltration on respiratory function of critical patients with influenza A/H1N1

作　　者：石斌[1] 张志刚[1] 李斌[1] 刘丽平[1] 尹超[1] 郭鸿[1] 侯启亮[1] 张斌[1] 曹永强[1] 

机构地区：[1]兰州大学第一医院重症医学科,730000

出　　处：《国际呼吸杂志》2011年第6期415-418,共4页International Journal of Respiration

基　　金：2009年兰州大学中央高校基本科研费自由探索项目（面上项目）（lzujbky2009100）

摘　　要：目的探讨持续静脉-静脉血液滤过（CVVH）对危重症甲型H1N1流感患者呼吸功能的影响。方法通过对入选的10例甲型H1N1流感危重症患者在常规治疗的基础上联合应用CVVH治疗，分别观察干预前及于预后24h、48h、72h、120h的血清炎性介质水平[肿瘤坏死因子α（TNF-α）、白介素6（IL-6）、IL-8、IL-10]、呼吸力学指标（气道压、静态顺应性、氧合指数）、St管外肺水、血气分析指标（PaO2、PaCO2、PH）及APACHEⅡ评分。结果与CVVH干预前相比，干预后72h、120h血液中的TNF-α、IL～6、IL-8均下降（P〈0．05）；cVVH治疗后72h患者的气道压、静态顺应性、氧合指数趋于稳定，与CVVH干预前相比差异有统计学意义（P〈0．05）；血管外肺水与治疗前相比，48h后开始逐渐回落（P〈0．05）；PaO2、PaCO2在CVVH72h后开始明显好转，与治疗前相比差异有统计学意义（P〈0．05），氧合指数的改变在48h后即有明显改善（P〈0．05），72h后一直稳定存正常水平；同时APACHEⅡ评分72h后也显著降低（P〈0．05）。结论CVVH可以清除危重症甲流患者部分炎性介质，清除血管外肺水，改善患者呼吸功能，提高抢救成功率。Objective To explore the effects of continuous veno venous hemofiltration （CVVH） on respiratory function of critical patients with influenza A/HIN1. Methods Ten cases of influenza A/H1N1 received CVVH on the basis of conventional therapy. Before and at 24th, 48th, 72nd, 120th hour after intervention, serum inflammatory mediators Etumor necrosis factor-a （TNF a） ,interleukin-6 （IL-6 ）, IL-8, IL-10, respiratory mechanics indexes （airway pressure, static compliance, oxygenation index）,extravascular lung water, blood gas analysis indexes （PaO2 ,PaCO2, pH） and APACHE 11 score were determined. Results Compared with before CVVH intervention, TNF-α, IL-6, IL-8 in blood at 72th, 120th hour after intervention were significantly decreased （ P 〈0.05）. There was statistical significance on airway pressure, static compliance, oxygenation index between before CVVH intervention and at 72th hour after intervention （ P d0.05）. Extravascular lung water gradually declined from 48th hour after intervention （ P 〈0.05）. Compared with before treatment, PaO2,PCO2 improved at 72th hour after intervention （ P 〈0.05）. Oxygenation index improved at 48th hour after intervention （ P 〈0.05）, and had been stable at normal level at 72th hour after intervention. Meanwhile, APACHE III score decreased at 72th hour after intervention （ P 〈0.05）. Conclusions For critical patients with influenza A/H1N1, CVVH can remove some inflammatory mediators and extravascular lung water, improve respiratory function, and increase the success rate of rescue.

关 键 词：持续静脉静脉血液滤过 甲型H1N1流感 呼吸功能 

分 类 号：R511.7[医药卫生—内科学]